Unusual cardiac malformations in Holt-Oram syndrome: report of two cases

The Holt-Oram syndrome is a hereditary disease which associated with upper limbs anomalies and cardiac defects such as secundum type atrial septal defect. Two cases of this syndrome with unusual cardiac findings are reported: One has an unroofing coronary sinus type atrial septal defect and preexcitation syndrome, the other has pentalogy of Fallot.

Prader-Willi syndrome with chromosome 15 interstitial deletion: report of one case

We report one classical case of Prader-Willi syndrome, and show the specific chromosome number 15 interstitial deletion. This one and half year old boy had the typical face of Prader-Willi syndrome and its characteristic histories of hypotonia, poor feeding, poor growth during early infancy, and then improved appetite and growth since the later half infancy. He also had bilateral cryptorchism and hypogonadism. With an aid of high resolution chromosomal banding technique, we found a small deletion including band 11 to 13 of the long arm of one of his chromosome number 15. This kind of chromosomal aberration is frequently found in Prader-Willi syndrome. This is the first case of Prader-Willi syndrome with chromosomal changes we found in Taiwan. Chromosomal changes may help both the diagnosis and the understanding of etiologies of many disease. We hope the ability to detect small chromosomal lesions will initiate our study to those hereditary diseases.

Vernal keratoconjunctivitis with shield ulcer--a case report

This 9-year-old boy had a three-year history of vernal keratoconjunctivitis. A shield ulcer developed in the superior part of the cornea. The shield ulcer is a rare manifestation of the disease. Although the cause of shield ulcer is unknown, the association of shield ulcer with large papillae suggests a mechanical cause. The symptoms of itching and mucous discharge were relieved after medications with topical steroid and cromolyn sodium, but the large shield ulcer was persistent. The vernal ulcer was treated with a 72 hours collagen shield. The ulcer healed rapidly within 5 days, leaving a corneal opacity about the level of Bowman's layer.

Restriction fragment length polymorphisms at the methylmalonyl CoA mutase locus in normal Chinese

L-methylmalonyl-CoA mutase (MCM; E.C. 5,4,99,2) is the apoenzyme for catalyzing the isomerization of L-methylmalonyl-CoA to succinyl-CoA. Genetic deficiency of MCM leads to the accumulation of precursors and abnormal metabolites of L-methylmalonyl-CoA. This can be associated with fulminant metabolic acidosis, widespread secondary aberrations in systemic metabolic homeostasis, mental retardation, or even neonatal death. This disorder is termed methylmalonic acidemia (MMA). This report, describes the use of an authentic, full-length cloned human cDNA probe, MCM26, kindly provided by Dr. Fred Ledley, for Southern blot analysis of genomic DNA. The pattern of EcoRI, Sac I and Hind III restriction endonuclease sites is reported from 14 unrelated control individuals of Chinese background. A Southern blot by EcoRI to the MCM26b probe reveals invariant bands of 4.1, 3.8, and 2.2 kb respectively. By EcoRI to the MCM26c probe, 7.2 kb is invariant. By HindIII to the MCM26c probe, invariant bands are 4.8 and 2.7 kb respectively. By SacI to the MCMb probe, invariant bands are 17, 8.0, 6.0, 3.6 and 1.8 kb respectively, while the polymorphic band is at 5.6kb. When combined with more diverse samples and additional polymorphisms, this restriction fragment length polymorphism may be useful for genetic diagnostic and linkage studies of MCM in MMA.

[Wilson disease presenting as fulminant hepatic failure, acute hemolytic anemia and renal failure: report of one case]

Wilson disease presenting as fulminant hepatic failure, severe hemolysis and renal failure is rare in the literature. A ten-year-old boy--complaining of abdominal pain, jaundice, tea-colored urine, and anemia was admitted to this hospital; examination showed Kayser-Fleischer rings, anemia associated with hemolysis, mildly elevated serum transaminases, extremely elevated bilirubin levels, low serum ceruloplasmin level, slightly elevated serum copper, excessive 24-hour urine copper excretion, and severe renal function insufficiencies. Under the impression of Wilson disease with fulminant hepatic failure, the patient was treated by oral D-penicillamine 1 gm per day, intravenous zinc sulphate (about 8 mg per day elemental zinc), and given other supportive treatment. Unfortunately, the patient died of hepatic failure complicated with septic shock 21 days after the onset of symptoms. Autopsy found liver copper content was 586.92 ug/gm dry weight and kidney copper content: 300.19 ug/gm dry weight, abnormally high as compared with normal tissue. A review of the literature led to conclusion that the best treatment for Wilson fulminant hepatic failure is liver transplantation.

45,XO/46,XY in a newborn with the stigmata of Turner syndrome: report of one case

A newborn with ambiguous external genitalia and the stigmata of Turner syndrome presented with the following features: short stature, hypertelorism, bilateral epicanthal folds, ptosis, low-set ears with prominent auricles, high-arched palate, low posterior hairline, webbed neck, broad and short chest, widely-spaced and hypoplastic nipples and clitoris-like phallus with hypospasdias. He also had patent ductus arteriosus, the secundum type of atrial septal defect and mitral stenosis. Chromosomes of peripheral blood showed mosaicism of cells with 45,XO/46,XY. An exploratory laparotomy was performed at five months of age. The right side ovotestis-like gonad was removed. The left side gonad in the scrotum was normal. No pathological gonadoblastoma was found.

Isovaleric acidemia: report of one case

A case of isovaleric acidemia appearing as diabetic ketoacidosis with acute encephalopathy and pancytopenia was reported. A three-year-old male patient, with mild psychomotor retardation, had recurrent bouts of acute encephalopathy and pancytopenia after episodes of upper respiratory infection. At admission, he had vomiting associated with dehydration, acidosis, ketonuria, coma and a pungent, rather unpleasant odor. Laboratory features included hyperglycemia, hyperammonemia, hyperamylasemia, hypocalcemia, neutropenia, thrombocytopenia and subsequent anemia. Urine organic acid profiles showed profuse amount of 3-beta-hydroxyisovaleric acid (295 mg/ml) and isovalerylglycine (616 mg/ml) by gas chromatography-mass spectrometry. Levels of amino acids in the serum and urine were normal. The patient received treatment with rehydration and insulin, with rapid improvement. After the acute illness, blood glucose levels returned to normal. The patient was doing well on a low-protein diet in recent 3 months.

Restriction fragment length polymorphisms at the ornithine transcarbamylase locus in normal Chinese

Ornithine transcarbamylase (OTC) (EC 2.1.3.3) is an hepatic mitochondrial enzyme involved in the detoxication of ammonia; it catalyzes the second step of the urea cycle, and is X-linked in human beings. Deficiency of OTC results in ammonia intoxication and, often, in early infant death, especially in males. This report describes the use of a nearly full-length cloned human cDNA for OTC for Southern blot analysis of genomic DNA. The pattern of MspI, TaqI, HindIII and EcoRI restriction endonuclease sites from 28 control individuals of Chinese backgrounds is reported. A Southern blot by Msp I reveals invariant bands of 19.5, 5.2 and 1.9 kb respectively, as well as one set of polymorphic bands 6.6/6.2 kb. By TaqI, invariant bands are 4.8, 2.7, 1.9, 1.7 and 1.4 kb respectively, while polymorphic bands are found at 4.1/3.9 kb. By HindIII, 3.2 kb is invariant but 4.0/2.9 kb polymorphic. By EcoR I, invariant bands are 9.0, 3.6, 3.4 and 1.45 kb respectively, but 2.5 kb is polymorphic. Combined with study of the alteration of restriction sites in the informative pedigrees, this information is expected to allow accurate heterozygote detection and prenatal diagnosis of OTC deficiency.

Wiedemann-Beckwith syndrome with congenital central hypothyroidism in one of monozygotic twins

A pair of monozygotic twins discordant for the Wiedemann-Beckwith syndrome (WBS) associated with congenital central hypothyroidism is described. During pregnancy, the mother was noted to have marked polyhydramnios and severe abdominal distension. At birth, a large diamniotic, monochorionic placenta was noted. According to a study of the minor blood groups and HLA typing, the possibility of monozygosity is 0.985. The mode of inheritance of the syndrome is debatable, and according to observations of discordance in monozygotic twins, single gene control seems unlikely. The thyroid function was noted to be subnormal when the proband was 3 days old. Oral thyroxine has been supplied since infancy. Repair of the umbilical hernia, the bilateral inguinal hernia, and a bilateral orchidopexy were done. A partial glossectomy was later performed to prevent progressive orofacial maldevelopment. The postnatal gigantism persisted as he grew.

Apert syndrome associated with septo-optic dysplasia

Apert syndrome and septo-optic dysplasia are rare congenital structural disorders which have not been associated previously; we report a female infant with this association. Brain sonography and computed tomography revealed agenesis of the septum pellucidum; optic hypoplasia was demonstrated by funduscopic evaluation. We postulate that an embryopathic factor, which manifests at 5-6 weeks gestation, may result in this new association. Transverse craniectomy was performed in the hope of preserving brain development. Neither hypopituitarism nor adrenal insufficiency was observed; however, clinical manifestations and laboratory data provided evidence of inappropriate antidiuretic hormone syndrome.

Clinical analysis of infants of diabetic mothers

The clinical spectra of 82 infants of diabetic mothers (IDMs) encountered in the past 15 years are presented. The perinatal mortality rate was 6.1%, The observed morbidities of the 78 live-born IDMs were: large for gestational age, 35.9%; prematurity, 12.8%; small for gestational age, 12.8%; respiratory distress, 17.9%; low Apgar score, 6.4%; nerve injury, 2.6%; hypoglycemia, 10.3%; hyperbilirubinemia, 28.2%; polycythemia, 12.8%; hypocalcemia, 5.1%; hypertrophic cardiomyopathy, 3.8%. Furthermore, 15.9% (13/82) of these infants suffered from congenital malformation, a rate nearly 10 times higher than that of the general neonatal population born in this hospital. In comparing sugar control during organogenesis, the mothers who had malformed infants had significantly higher fasting plasma glucose level than the mothers who had normal infants (P less than 0.05). Since tight control of maternal diabetes is mandatory to reduce the prevalence of mortality and malformation of the IDMs, we suggest that there is an urgent need to improve health education and supervision before and during pregnancy in all diabetic women.

Human sperm chromosome analysis in primary infertility: a preliminary report

Human sperm chromosomes can be analyzed using the zona-free hamster egg system. In order to familiarize ourselves with this new technique and to investigate the chromosome aberration frequency in fertile and possibly infertile men, we performed sperm chromosome analysis in 39 successful experiments. The subjects were divided into two groups. Group 1 was healthy men with proven fertility. Group 2 was husbands of couples with unexplained infertility. Semen samples were prepared freshly or preserved in TEST-yolk buffer for 12 to 72 hours. In group 1 using fresh samples, the mean penetration rate was 67.40 +/- 14.08% (mean +/- 2SD), the maturation index was 1.33 +/- 0.31. For samples treated with yolk buffer, the mean penetration rate was 91.34 +/- 7.42%, and the maturation index was 1.58 +/- 0.42. There was a statistically significant increase in penetration after yolk buffer treatment (p less than 0.001). In group 1 there were 89 haploid chromosomes, four were aneuploidy (4.5%), and three with structural aberrations (3.4%). In group 2, for fresh samples, the mean penetration rate was 71.34 +/- 27.96%, and the maturation index was 1.37 +/- 0.25. For samples treated with yolk buffer, the penetration rate was 86.33 +/- 25.18%, and maturation index 1.40 +/- 0.23. In group 2, there were 135 haploid chromosomes, 6 were aneuploidy (4.4%), and 4 with structural aberrations (3.0%). There was no statistically significant difference between group 1 and group 2 in the penetration rate, maturation index and frequency of chromosome abnormalities.

Mortality and survival in Down syndrome in Taiwan

In order to investigate the morbidity and mortality in individuals with Down syndrome(DS), we reviewed 237 cases of DS visiting our hospital in a ten-year period. There were 150 males and 87 females with age range from newborn to 25 years. The major illnesses included: 1) congenital heart disease (CHD), 42.6%; with endocardial cushion defect, ventricular septal defect, atrial septal defect and patent ductus arteriosus as the common types; 2) frequent or major respiratory tract infections, 34.2%; 3) summer fever, 5.5%; 4) major infective episodes other than pneumonia, 5.0%. Other diseases such as seizure disorder, gastrointestinal tract anomalies and thyroid dysfunction were also noted. There were 28 deaths of them and the causes of mortality were 1) CHD with congestive heart failure (CHD with CHF) and pneumonia (46.9%); 2) CHD with CHF and sepsis (10.7%); 3) CHD with CHF (14.3%) and 4) acute leukemia with infection (10.7%) respectively. Most of the mortality occurred during the first year of life, especially in patients with CHD. In our series, the one year survival rate was 93.6%; the result indicates that life expectancy in DS is much better than generally believed.

Further evidence for genetic heterogeneity of whistling face or Freeman-Sheldon syndrome in a Chinese family

We report on 2 brothers with severe manifestations of the whistling-face/windmill-vane-hand syndrome (also called "craniocarpotarsal dystrophy"; Freeman-Sheldon syndrome); they were born to normal, nonconsanguineous parents. Our observations support the theory of causal heterogeneity of this syndrome and suggest existence of an autosomal or X-linked recessive form of this syndrome.

Neonatal hepatitis: a follow-up study

Fifty-six patients with moderate to severe neonatal hepatitis were followed for 12 to 78 months. Two died from causes other than hepatitis itself and were free from liver disease at the time of death. Of the remaining 54 patients, seven died of hepatitis, two are living with chronic liver disease and psychomotor retardation, and 45 are living without liver disease. High peak bilirubin levels and liver histologic findings of periportal fibrosis, moderate to severe portal inflammation, and/or diffuse giant cell transformation appear to be major factors predictive for poor outcome. Cytomegalovirus (CMV) infection was a common associated infection. Evidence of CMV infection was found in 22 (49%) of the 45 patients studied. Three of them died, and one is still living with cirrhosis of the liver. Metabolic disorders such as alpha-1-antitrypsin deficiency, galactosemia, and aminoaciduria and/or aminoacidemia were carefully screened but were not found in these cases. A fatal case had a sibling who had died of a similar disease course. Chinese infants may have metabolic and familial cholestasis diseases requiring further investigation.

Effects of alpha-bungarotoxin and d-tubocurarine on the post-tetanic potentiation of the mouse diaphragm twitch tension

Effects of alpha-bungarotoxin (alpha-BuTX, 0.037-0.062 microM) and d-tubocurarine (d-Tc, 0.7-2.2 microM) on the post-tetanic potentiation (PTP) of the twitch tension were studied on the isolated mouse diaphragm preparation. In normal physiological solution, maximum PTP was obtained after 100 Hz tetanic stimulation for 5 sec. In preparations partially blocked by alpha-BuTX, PTP was less than in control preparations if tetanically stimulated at 100-200 Hz for 5-10 sec. In contrast, in preparations partially blocked by d-Tc (1-2.2 microM), PTP was increased if a higher frequency (500 Hz) was applied. This increase of the effect was independent of the duration of tetanic stimulation. Thus, d-Tc and alpha-BuTX have a different effect on PTP. The irreversibility of alpha-BuTX may contribute to the differences in mode of action of alpha-BuTX and d-Tc on the PTP of the twitch tension of the isolated mouse diaphragm.

[Job's syndrome--a case report (author's transl)]

A 4-year old boy with chronic eczema since early infancy had been admitted thrice to the hospital because of recurrent staphylococcal infections including furunculosis, lymphadenitis, pneumonia and pyothorax. Exhaustive immunologic studies revealed normal humoral, cell-mediated and non-specific immunities except extremely high serum IgE level and dysfunctions of granulocytes including decreased Fc and complement receptors, lowered chemotactic response (around the lower range of normal), slightly impaired intracellular killing of staphylococci and possibly impaired reactions to candida and BCG. In spite of long-term antimicrobial prophylaxis, cold abscesses continued to appear and the eczematous skin lesions waxed and waned.

[Common variable immunodeficiency: an immunological study (author's transl)]

A 17-year-old school boy with recurrent sinopulmonary infection and diarrhea was found to have marked hypogammaglobulinemia. He had no family history of similar disorder. Serum IgG was measured 240 mg/dl, whereas all the other classes of immunoglobulins were undetectable with Mancini's technique. The polymorphonuclear leukocyte function and complement system were normal. Although the numbers of T and B lymphocytes were normal, we demonstrated that the patient's B cells were able to produce only IgG in subnormal amount and unable to secrete other classes of immunoglobulins. No hyperactive suppressor T cell function or inadequate helper T cell function was found. Therefore, the basic immmunopathogeneic mechanism was ascribed to intrinsic B cell defect.